Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Implementation of a lifestyle-based clinical pathway in daily clinical practice in men undergoing androgen deprivation therapy for prostate cancer (#74)

Renée Bultijnck 1 2 , Anniek Bruggeman 3 , Barbara Van Ruymbeke 3 , Stefanie Mortier 4 , Anneleen Raes 4 , Elke Rammant 1 , Martine De Muynck 3 , Benedicte Deforche 5 6 , Valérie Fonteyne 1 , Karel Decastecker 1 , Nicolaas Lumen 1 , Piet Ost 1 2
  1. Department of Human Structure and Repair, Ghent University, Ghent, Belgium
  2. Research Foundation - Flanders (FWO), Brussels, Belgium
  3. Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
  4. Cancer Center, Ghent University Hospital, Ghent, Belgium
  5. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  6. Department of Physical Activity, Nutrition and Health, Vrije Universiteit Brussel, Brussels, Belgium

Aims

To assess the effect of a lifestyle-based prostate cancer pathway, incorporated in daily practice, to increase the implementation of evidence-based strategies to manage ADT-induced side effects.

Methods

PCa patients receiving ADT for >6 months were referred to the pathway (i.e. as standard practice), through a central coordinator. The pathway consisted of a medical screening (i.e. bone and cardiometabolic screening) and a rehabilitation program with a supervised exercise program (3months) and referrals to a dietician and a psychologist. Anthropometric parameters and physical performance were measured at baseline and after 3 months. Primary endpoint was physical performance evaluated with the 400m walk test. Planned referral target was set at 200 to accomplish a sample size of 120 patients following the exercise program. A meaningful clinically important difference of the 400m test was defined as 17 seconds improvement and p<.05 was considered statistically significant. 

Results

Between January 2015 and June 2018, 200 patients were referred to the pathway, of which 177 were enrolled (median age 69, IQR 63-74). The majority (84%) had a good functional status (Karnofsky Performance ≥90) at baseline. The indication for ADT was curative in combination with local therapy for locally advanced PCa in 67% and palliative for (non)metastatic PCa in 33% of patients. In total, 124 followed the complete pathway. Medical screening indicated a lower bone mineral density in 51% of the patients and 25% had metabolic syndrome. After initial referral, 43% choose to receive diet advice and 64% psycho-education. A clinically meaningful performance improvement was observed in patients following the exercise program (282s to 253s; p<0.001). Compliance rate of the exercise program was high (83%). 10% dropped-out due to medical reasons. After the 3-month exercise program, 81% voluntary continued.

Conclusion

Physical performance improved after following a lifestyle-based clinical pathway for prostate cancer patients in daily practice.